RNOH PPI Forum – Report

Subject: Fact finding visit to Orthotics

Date:April 8th 2008, 10.30 am – 12 pm

PP group members:Angela O’Halloran, Marion Cumbers

Staff interviewed: Kelvin Smith, Department Manager

Chris Truman, Production Manager

Patients interviewed: One adult, one child

Parents interviewed: None available

Area visited: NHSOrthotics unit and workshops – providing items such as corrective casts, calipers, special footwear etc. The prosthetics unit which provides replacement limbs etc. is a separate commercial organisation run from NorthwickPark.

  • Staff: 29.2 FTE, half manufacture, half clerical and clinicians
  • Patients are referred by orthotic consultants, directly by GPs or can telephone for a review appointment.
  • Waiting time: 5 weeks for a new patient, review appointments join the same queue.
  • The reception desk is adjacent to the main office so is well staffed. Clinical staff have a rather cramped office with eight computers. There are sufficient clinical rooms not to cause delays.
  • General environment: The public area is clean, welcoming and child-friendly. The walls are bright with large cartoons and the waiting area has good selection of toys and books. There are tropical fish in a tank to watch. Drinking water is available, and the chairs are sensibly designed with strong arms for those with mobility problems. A patient suggestion box is prominently displayed.
  • Alcohol gel is available for staff and visitors. There are beautifully appointed and clean toilets, including capacious provision for wheelchair users.
  • Access: Aninformation leaflet is given to patients describing access arrangements and transport. It mentions the minibus link, which stops outside orthotics, but does not mention that it is free for patients. The hospital map shows the location of the unit, but signage on the ground appeared to be inadequate for strangers unfamiliar with the hospital area.
  • The Orthotics department have their own workshops and small plaster area. They also make casts in the main plaster theatre, or at Bolsover Street. Although dust-causing and noisy procedures were being carried out, no goggles, masks or ear protectors were being worn by the craftsmen. They can wear them if they want to - however they were not on view. There is also an extractor fan to keep down the dust, but this was also not being used. Some machines have automated extraction.
  • There appears to be no planned professional training or updating for the craftsmen. Most have worked in the department for many years and are approaching retirement, yet there appear to be no plans for the training of younger replacements or the preservation of their skills in the manufacture of special appliances so important to the quality of life of patients. Each year a student spends time in the unit on a placement from their university course, but they are few.
  • There is a small amount of plaster residue etc. on the floors of the workshops which is only to be expected in a working area.
  • Patients come from the wards or the outpatient department or directly from home. They can contact the department direct if they need advice or a follow-up appointment. Like the plaster theatre, the orthotics department keeps separate patient records that do not join a patient’s hospital notes. Full use does not appear to be being made of the PACS system, but possibly this is not appropriate.
  • Patients did not complain of extended waits, and said they were well cared for and had no complaints. The patient interviewed was not being seen by the same clinician at each visit, which she regretted. The manager described continuity as a desirable feature of the department, but it appears not to be happening.
  • At the moment the waiting list is about 5 weeks for an initial appointment. The timing of the 18 week patient journey starts when the referral letter enters the system. This does not apply to long-term patients returning regularly. Patient porterage is not a problem as they are used only for deliveries. For in-patients there is an orthtotist on duty morning and afternoon who visits the wards on request. They aim to respond within half a day. There are sometimes complaints that the service is not speedy enough, but this is usually due to lack of materials or unavoidable delay in manufacturing processes. Orthotists can use whatever materials or devices they think best, but within limits of cost, which has to be justified. The unit has an annual budget, which is sufficient, but always over-spent.

Points needing attention:

  • Health and safety of the operatives. Policy on ear, eye and lung protection needs to be in place and enforced for their own safety
  • Succession planning and training schemes for new operatives. If no external courses exist, maybe the hospital could consider running one themselves or liaising with a local college or university for the provision of an apprenticeships scheme.
  • There appear to be advantages for patients, in terms of speed of response, in having a dedicated department on site. The benefits of being based elsewhere are difficult to see.
  • Is it intended that patients still have a number of different manual folders of notes? Was PACS not meant to replace these?
  • Signage is a problem, as often appears to be the case on the site. It is a very long way to Orthotics if parked as soon as possible after entering by the main gate. More signposts would not go amiss. In the leaflets, an alphabetical list of areas, departments and wards might be easier for strangers to use, not knowing under what heading to look.
  • The access leaflet mentions the minibus service (though not that it is free), but there is no mention at Stanmore Station that it runs every 15 minutes, is free, and can be used by patients.
  • The map on the web, which you get by searching for “RNOH map” in Google, cannot be made more than one size larger. “View, text size” does not work, as the map is a graphic, and it cannot be searched e.g. for the word “Orthotics”, which it could be if it was published as a .pdf file.

Our visit was useful and informative, and we thank the staff of the department for their time and courtesy in showing us round.